Evaluation of Orthopedic morbidities among patients attending the Casualty Department in a Medical C

Orthopedic morbidities among patients

International Archives of Integrated Medicine, Vol.

Copy right © 2014, IAIM, All Rights Reserved.

Original Research Article

Evaluation of O

patients attending the Casualty Department

in a Medical College Hospital

Lakshmeesha T1Assistant Professor, Department of Orthopedics, Hassa

2Associate Professor, Department of Community Medicine, Hassa

*Corresponding author email:

How to cite this article: Lakshmeesha T, Praveen G

patients attending the Casualty Department in a Medical College Hospital

Available online at

Received on: 30-11-2014

Abstract

Introduction: Injuries are becoming major public health problem worldwide and since

passing through a major socio-demographic, epidemiological and technological transition injuries are

coming up as an emerging health problem. This study was aimed at analyzing the morbidities of

orthopaedic injuries among patients attending t

Material and methods: The record analysis of injured patients attending the casualty department

over a 12 months period from Jan 2013 to Dec 2013 was done. The data was analyzed to know the

pattern of orthopedic injuries.

Results: A total of 1100 injured patients attended the casualty department were analyzed. Study

showed that 880 (80%) of victims were in the age group of 11

275 (25%) were females. Road traffic acciden

responsible for 660 victims (60%) followed by fall from height 242 (22%). Study revealed that in 770

(70%) of the victims the most common presentation of morbidity was fracture and the most

common site was lower limbs in 378 (49%). Next most common site was upper limbs followed by

pelvic fracture, spine fractures, facial fracture & Ribs fracture. 792 (72%) cases had simple fracture.

44 (13%) cases had various dislocations, shoulder dislocation being the mo

common visceral injury was head injury 198 (18%).

Conclusion: Fractures were the most common pattern of orthop

with head injuries. Research into appropriate strategies for prevention of injuries, especially RTA is

required in medical college hospital.

morbidities among patients

International Archives of Integrated Medicine, Vol. 1, Issue. 4, December, 2014.


Orthopedic morbidities among



Lakshmeesha T1, Praveen G

2*

Assistant Professor, Department of Orthopedics, Hassan Institute of Medical

Associate Professor, Department of Community Medicine, Hassan Institute of Medical Sciences,

India

*Corresponding author email: [email protected]

Lakshmeesha T, Praveen G. Evaluation of Orthopedic

patients attending the Casualty Department in a Medical College Hospital. IAIM, 2014; 1(4

Available online at www.iaimjournal.com

2014 Accepted on:

Injuries are becoming major public health problem worldwide and since

demographic, epidemiological and technological transition injuries are


orthopaedic injuries among patients attending the casualty department in a medical college hospital.

: The record analysis of injured patients attending the casualty department

months period from Jan 2013 to Dec 2013 was done. The data was analyzed to know the

A total of 1100 injured patients attended the casualty department were analyzed. Study

showed that 880 (80%) of victims were in the age group of 11-45 years. 825 (75%) were males and

275 (25%) were females. Road traffic accident (RTA) was the most common cause of injuries being



s lower limbs in 378 (49%). Next most common site was upper limbs followed by


44 (13%) cases had various dislocations, shoulder dislocation being the mo

common visceral injury was head injury 198 (18%).

ere the most common pattern of orthopedic injuries, frequently associated


required in medical college hospital.

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Page 58

rthopedic morbidities among



n Institute of Medical Sciences, India

n Institute of Medical Sciences,

Evaluation of Orthopedic morbidities among

IAIM, 2014; 1(4): 58-62.

Accepted on: 03-12-2014

Injuries are becoming major public health problem worldwide and since India is also

demographic, epidemiological and technological transition injuries are


he casualty department in a medical college hospital.

: The record analysis of injured patients attending the casualty department

months period from Jan 2013 to Dec 2013 was done. The data was analyzed to know the

A total of 1100 injured patients attended the casualty department were analyzed. Study

years. 825 (75%) were males and

was the most common cause of injuries being



s lower limbs in 378 (49%). Next most common site was upper limbs followed by


44 (13%) cases had various dislocations, shoulder dislocation being the most common. Most

injuries, frequently associated





Key words

Fracture, Orthopedic injuries, Road traffic accident

Introduction

Road traffic accidents are responsible for a

substantial proportion of deaths and

are responsible for more years of life lost than

most human diseases. Road traffic accidents are

a growing problem worldwide accounting for

around 1.2 million deaths and over 50 million

injuries annually [1]. It is expected that by the

year 2020, RTA will rank third in the global

burden of diseases [2]. This level of attention to

road safety underscores the global burden of

road traffic injuries and the need for public

health concerned towards reducing this

epidemic. India is still in the deve

stages with relatively few published data, thus

documentation of injuries is inadequate and

posing great difficulty in assessing these data.

This study was designed to identif

characteristics of orthopedic injuries as seen in

the Hassan institute of Medical sciences and

identify potential areas of development to

enhance trauma research, an important adjunct

to effective policy formulation and

implementation.

Material and methods

This was a retrospective study of record analysis

conducted at the casualty department of

Institute of Medical Sciences. The patients

attending the casualty department of Hassan

institute of Medical sciences during Jan 2013 to

Dec 2013 were included in this study. Personal

data and pattern of injuries sustained were

extracted from the case records, casualty

register and operation records. Data extraction

was manually done by reviewing each case file

since there was no trauma registry.




Fracture, Orthopedic injuries, Road traffic accidents.

Road traffic accidents are responsible for a

bstantial proportion of deaths and injuries and

are responsible for more years of life lost than

most human diseases. Road traffic accidents are

a growing problem worldwide accounting for

around 1.2 million deaths and over 50 million

. It is expected that by the

RTA will rank third in the global

This level of attention to

road safety underscores the global burden of

road traffic injuries and the need for public

health concerned towards reducing this

epidemic. India is still in the developmental

stages with relatively few published data, thus

documentation of injuries is inadequate and

posing great difficulty in assessing these data.

This study was designed to identify the

edic injuries as seen in

itute of Medical sciences and

identify potential areas of development to

enhance trauma research, an important adjunct

to effective policy formulation and

This was a retrospective study of record analysis

conducted at the casualty department of Hassan

ciences. The patients

attending the casualty department of Hassan

institute of Medical sciences during Jan 2013 to

in this study. Personal

data and pattern of injuries sustained were

extracted from the case records, casualty

register and operation records. Data extraction

was manually done by reviewing each case file

since there was no trauma registry.

Results

During the 12 months study period, 1100 injured

patients were seen in the casualty department.

880 (80%) of victims were in the age group of

11-45 years. There were 825 (75%) males and

275 (25%) females. Road traffic accident was the

most common cause of injurie

responsible for 660 (60%) of patient injuries.

Other causes were fall from height in 242 (22%),

fall from stairs in 16 cases (1.5%), fall on ground

in 11 cases (1 %), occupational injuries in 77

cases (7%), assault in 88 cases (8%), sports

related in 6 cases (0.5%) as per

revealed that in 770 (70%) cases the commonest

injury was a fracture and the most common site

was lower limbs in 378 (49%) with the tibia or

fibula being the most common bones to be

fractured. Next common site was

220 (28.5%) followed by pelvic fractures 60

(7.9%), spine fractures 70 (9.1%), facial fractures

20 (2.6%) and rib fractures 22 (2.9%). 555 (72%)

cases had simple fractures and remaining 215

(28%) cases had compound fractures

Table - 2 and Table - 3.

Table - 1: Distribution of patients based on the

orthopaedic injuries.

Orthopedic injuries

RTA

Falls

Fall from height

Fall from stairs

Fall on ground

Occupational injuries

Assault

Sports related

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Page 59

the 12 months study period, 1100 injured

patients were seen in the casualty department.

880 (80%) of victims were in the age group of

years. There were 825 (75%) males and

275 (25%) females. Road traffic accident was the

most common cause of injuries being

responsible for 660 (60%) of patient injuries.

Other causes were fall from height in 242 (22%),

fall from stairs in 16 cases (1.5%), fall on ground

in 11 cases (1 %), occupational injuries in 77

cases (7%), assault in 88 cases (8%), sports

%) as per Table - 1. Study

revealed that in 770 (70%) cases the commonest

injury was a fracture and the most common site

was lower limbs in 378 (49%) with the tibia or

fibula being the most common bones to be

fractured. Next common site was upper limbs

220 (28.5%) followed by pelvic fractures 60

(7.9%), spine fractures 70 (9.1%), facial fractures

ib fractures 22 (2.9%). 555 (72%)

cases had simple fractures and remaining 215

(28%) cases had compound fractures as per

Distribution of patients based on the

Number (%)

660 (60%)

242 (22%)

16 (1.5%)

11 (1%)

77 (7%)

88 (8%)

6 (0.5%)





type of injuries.

Type of injuries Number (%)

Fracture 770 (70%)

Fracture of lower limb 378 (49%)

Fracture of upper limb 220 (28.5%)

Pelvic fractures 60 (7.9%)

Spine fracture 70 (9.1%)

Facial fractures 20 (2.6%)

Rib fractures 22 (2.9%)

Dislocation 44 (4%)

Sprain and Strain 154 (14%)

Lacerations 110 (10%)

Contusions 55 (5%)


types and number of fractures.

Variables Number (%)

Types of fracture

Simple fracture 555 (72%)

Compound fracture 215 (28%)

Number of fracture

Single bone fracture 400 (52%)

Two bone fracture 231 (30%)

Multiple bone fracture 139 (18%)

Single bone fracture was present in 400 (52%)

cases, two bone fractures was present in 231

(30%) cases and multiple fractures were seen in

139 (18%) cases as per Table -

(4%) cases of various dislocation, shoulde

dislocation being the most common.

The sprain and strain of ligaments and muscles

were present in 154 (14%) cases only laceration

was present in 110 (10%) cases and contusions

with intact skin were present in 55 (5%) cases.

Most commonly associated visc

the head injury in 198 (18%). Pelvic injuries in 33

(3%) cases, thoracic injuries in 17 (1.5%) cases,

abdominal injuries were present in 17 (1.5%)





Number (%)

770 (70%)

378 (49%)

220 (28.5%)

60 (7.9%)

70 (9.1%)

20 (2.6%)

22 (2.9%)

44 (4%)

154 (14%)

110 (10%)

55 (5%)


Number (%)

555 (72%)

215 (28%)

400 (52%)

231 (30%)

139 (18%)

Single bone fracture was present in 400 (52%)

cases, two bone fractures was present in 231

(30%) cases and multiple fractures were seen in

3.There were 44

(4%) cases of various dislocation, shoulder

dislocation being the most common.

The sprain and strain of ligaments and muscles

were present in 154 (14%) cases only laceration

was present in 110 (10%) cases and contusions

with intact skin were present in 55 (5%) cases.

Most commonly associated visceral injury was

the head injury in 198 (18%). Pelvic injuries in 33

(3%) cases, thoracic injuries in 17 (1.5%) cases,

abdominal injuries were present in 17 (1.5%)

cases and genitourinary in 11 (1%) cases. No

visceral injuries were found in 824 (75%)

as per Table - 4.


associated visceral injuries.

Visceral Injury Number (%)

No visceral injury 824 (75%)

Head injury 198 (18%)

Pelvic injury 33 (3%)

Thoracic injury 17 (1.5%)

Abdominal injury 17 (1.5%)

Genitourinary

injury

11

Discussion

Our study showed that road traffic accidents are

the commonest cause of injury in our center.

This high prevalence of RTA,

noteworthy as it has implications for the

provision of adequate facilities for managing

road traffic injuries. This high rate is probably

because of the location of the study center on

National Highway – 75. In the present study,

other modes of injuries were falls in 270 (24.5%)

cases, occupational injuries in 77 (7%) cases,

assault in 88(8%) cases and sports related in 6

(0.5%) cases.

Solagberu, et al. [3] has reported 62.3%

prevalence of RTA in their trauma series from

Nigeria. In a study conducted b

[4] in 2004 found that RTA was responsible for

52% of injuries; fall for 13%, occupational

injuries constituted 4% and ass

injuries. In the study by Huda N

commonest mode of injury was roadside

accident seen in 48.13% cases, followed by fall in

29.5%, assault in 5.4%, occupational injuries

10.5% and sports related in 4.17%.

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cases and genitourinary in 11 (1%) cases. No

visceral injuries were found in 824 (75%) cases


Number (%)

824 (75%)

198 (18%)

33 (3%)

17 (1.5%)

17 (1.5%)

11 (1%)

that road traffic accidents are

the commonest cause of injury in our center.

This high prevalence of RTA, 60%, was

noteworthy as it has implications for the

provision of adequate facilities for managing

road traffic injuries. This high rate is probably

because of the location of the study center on

75. In the present study,

were falls in 270 (24.5%)

cases, occupational injuries in 77 (7%) cases,

assault in 88(8%) cases and sports related in 6

] has reported 62.3%

prevalence of RTA in their trauma series from

Nigeria. In a study conducted by Gururaj G, et al.

in 2004 found that RTA was responsible for

52% of injuries; fall for 13%, occupational

injuries constituted 4% and assault 3% of total

injuries. In the study by Huda N, et al. [5], the

commonest mode of injury was roadside

seen in 48.13% cases, followed by fall in

29.5%, assault in 5.4%, occupational injuries

10.5% and sports related in 4.17%.




In the present study, maximum number of

victims was between 11-45 years (

age distribution has been reported in other

studies from developing countries

11]. Considering the maximum involvement of

individuals in the economically productive years,

RTA may have an important economic impact. It

also implies that interventions should be

designed so as to target these individuals.

Majority of those injured in the present study

were males 825 (75%) and 275 (25%) were

females. This is in conformity with other studies

in India [6, 9, 10, 11, 12, 13, 14]

of males attributed to their greater exposure t

traffic and more risky behavior than females.

In the present study, fractures were the most

frequently seen injuries accounting for 770

(70%) of all injuries and the most common site

was lower limb in 378 (49%). A cross sectional

study in India showed that fractures were the

commonest injury among the victims of nonfatal

road traffic accidents, and majority of the

victims were in the age group of 18

[15]. Another hospital based study of 450 cases

admitted due to traffic accidents in India

revealed that commonest type of injury was a

fracture (49.33%) and the most

fracture was a lower limb (48.2%

In the present study simple fractures were seen

in 555 (72%) cases and compound fractures

were present in 215 (28%) cases. In a study by

Malhotra C, et al. [17], compound fractures

were present in 31.6% cases. In the study Huda

N, et al. [5], compound fractures were seen in

39.9% cases and simple fractures were present

in 66% cases.

Conclusion

Fractures were the most common pattern of

Orthopaedic injuries. They were frequently




maximum number of

45 years (82%). Similar

age distribution has been reported in other

tudies from developing countries [6, 7, 8, 9, 10,

. Considering the maximum involvement of

individuals in the economically productive years,

RTA may have an important economic impact. It

also implies that interventions should be

these individuals.

Majority of those injured in the present study

were males 825 (75%) and 275 (25%) were

females. This is in conformity with other studies

]. Preponderance

of males attributed to their greater exposure to

traffic and more risky behavior than females.

fractures were the most

frequently seen injuries accounting for 770

(70%) of all injuries and the most common site

was lower limb in 378 (49%). A cross sectional

study in India showed that fractures were the

commonest injury among the victims of nonfatal

road traffic accidents, and majority of the

victims were in the age group of 18-37 years

. Another hospital based study of 450 cases

admitted due to traffic accidents in India

revealed that commonest type of injury was a

) and the most common site of

e was a lower limb (48.2%) [16].

In the present study simple fractures were seen

in 555 (72%) cases and compound fractures

were present in 215 (28%) cases. In a study by

, compound fractures

6% cases. In the study Huda

ctures were seen in

tures were present

Fractures were the most common pattern of

Orthopaedic injuries. They were frequently

associated with other injuries especi

injuries. Research into appropriate strategies for

prevention of injuries especially RTA, is required,

but this must start with the establishment of

institutional and regional trauma registries for

complete documentation of relevant

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ISSN: 2394-0026 (P)

ISSN: 2394-0034 (O)

Page 61

njuries especially head

to appropriate strategies for

prevention of injuries especially RTA, is required,

but this must start with the establishment of

institutional and regional trauma registries for

complete documentation of relevant data.

World Health Organization. World

report on road traffic injury prevention.

World Health Organization, Geneva,

CJL, Lopez AD (Editors). Global

Burden of Disease: A comprehensive

assessment of mortality and disability

from diseases, injuries, and risk factors

in 1990 and projected to 2020. Harvard

School of Public Health, 1996.

Solagberu BA, Adekanye AO, Ofoegbu

K, Kuranga SA, Udoff a US, Abdur-

Rahman LO, Odelowo EOO. Clinical

spectrum of trauma at a university

hospital in Nigeria. Eur J Trauma, 2002;

Gururaj G, Girish N., Issac N., KK

Subhakrishna DK. final report of the

project “health behavior surveillance”

submitted to the ministry of health and

family welfare. Govt. of India, 2004.

Huda N., Parekh P, Rehman M, Afzal M,

Siddiquie HQ. Demographic distribution

of fractures at a tertiary care hospital in

western U.P. (India) - A retrospective

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Jha N, Srinivasa DK, Roy G, Jagdish S.

Injury pattern among road traffic

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India. Indian Journal of Community

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Source of support: Nil

Conflict of interest:

ISSN: 2394-0026 (P)

ISSN: 2394-0034 (O)

Page 62

Safdarjung Hospital, New Delhi. Indian J

Med Res, 1968; 56(4): 456-466.

Ghosh PK. Epidemiological study of the

victims of vehicular accidents in Delhi. J

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Nil

None declared.

Documents

Evaluation of Orthopedic morbidities among patients attending the Casualty Department in a Medical C